Splint with flexible body for repair of tendons or ligaments and method

ABSTRACT

A surgical repair splint (21,41,61,81,121) for use with a securement device such as a plurality of sutures (31,51,71,91,131) to hold together opposed ends of a member, such as a tendon or ligament (24,64,84,124), during preparing and healing of the member. The repair splint (21,121) has an elongated splint body, which can be flexible and which can either be pushed or pulled into the opposite ends (22,23,122,123) of the member to be repaired, or placed along a side of the opposed ends. The repair splint further includes securement structures or oppositely facing shoulders (32,33,132,133) on relatively rigid pointed splint ends (26,27,126,127) which are formed to receive and cooperate with a securement device, such as sutures (31,131), so as to secure the opposite tendon or ligament ends to the splint against separation of the opposed faces (28,29,128,129) which are to be knit together during healing. A method of surgical repair of ruptured or severed tendon or ligament ends is also provided.

CROSS-REFERENCE TO RELATED APPLICATION

This is a continuation-in-part of my prior application, Ser. No.08/504,587, filed Jul. 20, 1995, now U.S. Pat. No. 5,723,008.

TECHNICAL FIELD

The present invention relates, in general, to apparatus and methods forrepair of ruptured or severed tendons and ligaments, and moreparticularly, relates to surgical operative techniques for joiningtogether the opposed ends of such members in order to effect repair.

BACKGROUND ART

Surgical repair of tendons and ligaments, and particularly flexortendons, has been accurately described as a "technique-intensivesurgical undertaking." The repair must be of sufficient strength toprevent gapping at the opposed end faces of the repaired member and topermit post-repair application of rehabilitating manipulation of thetendon or ligament.

Considerable effort has been directed toward the development of varioussuturing techniques to repair severed or ruptured tendons and ligaments.The technique which is probably in most widespread use is by repair ofthe tendons using various suture techniques. The most common suturetechnique is known as the Kessler repair, which involves the use ofsutures that span in a particular configuration or pattern across theopposed severed ends of the tendon or ligament. There are, however, awide variety of suturing patterns which have been developed in an effortto attempt to increase the tensile strength across the surgical repairduring the healing process. Evans and Thompson in an article entitled"The Application of Force to the Healing Tendon" in the Journal of HandTherapy, October-December, 1993, pages 266-282 survey the varioussuturing techniques which have been employed in surgical tendon repair,and in two articles by Strickland in the Journal of American Academy ofOrthopaedic Surgeons entitled "Flexor Tendon Injuries: I. Foundations ofTreatment" and "Flexor Tendon Injuries: II. Operative Technique", Volume3, No. 1, January/February, 1995, pages 44-62, the various techniquesalso are described and illustrated.

Generally, the tensile force at which a tendon repair joint will failincreases with increased complexity of the suturing scheme. As can beseen from the Evans and Thompson article, the loads which failure occuracross a sutured joint can vary between about 1,000 grams to reportedfailures as high as about 8,000 grams. The Kessler and modified Kesslertechniques are relatively simple in their suturing pattern, but theytend to have a failure strength toward the low end of the range, forexample, between about 1,500 to 4,000 grams.

As is reported in Evans and Thompson, at least one researcher hasemployed a Mersilene mesh sleeve having a size slightly larger than thetendon that is sutured to the opposed tendon ends. Using the sleeveexperimental failure loading as high as 10,000 grams was reported.Mersilene, which is the material that sutures are often made of, has thedisadvantage that human tissue will adhere or experience adhesion to theMersilene. This is undesirable in flexor tendons and ligaments since thetendon must be able to glide relative to the surrounding tissue duringthe flexing process. Moreover, a sleeve may be well suited for use withtendons and ligaments which are substantially cylindrical, but itbecomes less easily employed with tendons having a flat or ovaloid crosssection.

In an article by Mitsuhiro, et al. in The Journal of Hand Surgery, Vol.19A, No. 6, November, 1994, pp 984-990, entitled "Tendon Repair UsingFlexor Tendon Splints: An Experimental Study" techniques are describedfor surgically repairing tendons using a tendon splint. In one approachthe opposed tendon ends are slit and the splint, a generally rectangularDacron member, spans across and is positioned in each slit tendon end.This internally positioned splint is then sutured in place across thetendon ends using various suturing patterns. In another approachdescribed in the Mitsuhiro, et al. article, the rectangular splint issutured to the back side of the tendons across the severed ends. Asnoted by Mitsuhiro, et al., both these techniques have disadvantages.The positioning of a splint internally by slitting the tendon ends maydamage tendon blood supply, and the external positioning of a Dacronsplint can interfere with tendon gliding.

Accordingly, development of surgical tendon and ligament repairtechniques that are less technique-intensive and yet have a highstrength across the repaired joint is a highly desirable goal. Suchrepair techniques should minimize the adhesion potential and permitmember excursions during manipulation to effect rehabilitation.

It is an object of the present invention, therefore, to provide a tendonor ligament splint which can be used to splint together opposed ends ofthe tendon or ligament in a relatively simple procedure to provideenhanced joint strength.

A further object of the present invention is to provide a tendon orligament splint and method which have improved compatibility with thebody and are suitable for joining flexor tendons and ligaments, whichnormally must experience substantial longitudinal excursions withoutadhesion to surrounding tissue.

Still another object of the present invention is to provide a surgicalmethod of repairing or joining together opposed tendon or ligament endswhich is less tedious and time-consuming and yet provides ahigh-strength, body-compatible tendon joint.

The surgical tendon or ligament splint and method of the presentinvention have other objects and features of advantage which will becomeapparent from, and are set forth in more detail in, the accompanyingdrawing and following description of the Best Mode of Carrying Out TheInvention.

DISCLOSURE OF INVENTION

A surgical repair splint is provided for use with a securement device,such as one or more sutures, to repair or hold together opposed endfaces of a ruptured or severed tendon or ligament during the healing orknitting of the ends together. In one embodiment the elongated splint isprovided with a relatively flexible central splint body, for example, ametallic suture, to which a pair of relatively rigid pointed splint endsare coupled. The splint ends can be oppositely facing frusto-conicalmembers which have pointed ends that penetrate the opposed ends of thetendon or ligament and provide wide ends that act as shoulders acrosswhich transverse sutures can extend to resist separation of the tendonor ligament ends. A needle and tendon can be secured to each pointedsplint end to enable the splint to be pulled into the tendon or ligamentends for securement to the tendon by a transverse suture.

In another embodiment the splint takes the form of a thin, flat metalstrip having a length dimension sufficient to extend inwardly of each ofthe opposed ends by a distance enabling securement of the splint body toeach of the opposed ends of the member by the securement device, e.g., atransversely extending suture. Additionally, the splint body further isformed with a securement structure, such as a shoulder or hole,proximate each opposed splint end having a configuration whichcooperates with the securement device to resist axial displacement ofthe end faces away from each other. In both embodiments the splint isformed with a width dimension less than the width dimension of theopposed tendon or ligament end faces so that it will not significantlyimpede longitudinal excursions of the tendon or ligament during healing.

In a further aspect of the present invention, a method of joiningtogether opposed ends of a ruptured or severed tendon or ligament isprovided which is comprised, briefly, of the steps of positioning theopposed ends in axially aligned and substantially abutting relationship,placing an elongated splint having securement structures thereon in aposition to span across the opposed tendon or ligament ends, adheringeach of the opposed ends to the securement structures provided on thesplint, preferably by suturing, and allowing the opposed ends to knittogether while sutured to the splint. In one embodiment, the placingstep is accomplished by penetrating the opposed end faces of the tendonor ligament with an elongated splint having pointed splint ends and awidth dimension less than the opposed ends of the tendon or ligamentinto the opposed end faces of the tendon or ligament until the opposedtendon ends are axially aligned and in substantially abuttingrelationship to permit securement, preferably by suturing, of theopposed ends to the splint.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a top perspective, schematic view of a tendon or ligamenthaving a surgical repair splint constructed in accordance with thepresent invention embedded therein and sutured thereto.

FIG. 2 is a side elevation view, partially broken away, of the tendon orligament repair of FIG. 1.

FIG. 3 is a side elevation view corresponding to FIG. 2 of analternative embodiment of the microsurgical repair splint of FIGS. 1 and2.

FIG. 4 is a top perspective, schematic view of a flat tendon or ligamentshowing a further alternative embodiment of the microsurgical repairsplint of the present invention sutured to a side thereof.

FIG. 5 is a top plan view of the assembly shown in FIG. 4.

FIG. 6 is a top plan view of an alternative embodiment of the splint ofFIGS. 4 and 5.

FIG. 7 is a side elevation view of a further alternative embodiment ofthe splint of the present invention showing placement needles andshowing, in phantom, a tendon and securement sutures.

BEST MODE OF CARRYING OUT THE INVENTION

The present invention provides an elongated splint for use in surgicalrepairs of tendons, ligaments and similar elongated tissue that canbecome severed or ruptured or otherwise separated. The object of anysuch repair is to join the opposed ends of the severed member at arepaired joint which has sufficient strength that it will be effectivein holding the ends together during healing. In connection with tendonsand ligaments, and particularly flexor tendons, it is generally thoughtto be highly desirable to be able to manipulate or apply passive oractive stress to cause longitudinal excursions of the tendon under lowloading to encourage rehabilitation.

While such repairs can be effected, as indicated above, through the useof sutures alone, in the apparatus and method of the present inventiontendon joining repair splints are provided which can be relativelyeasily used to produce substantially enhanced tendon and ligamentrepairs. While most preferably applied to humans, it also will beappreciated that the apparatus and method of the present invention aresuitable for use for repairs in other animals.

Referring now to FIGS. 1 and 2, an elongated surgical repair splintmember, generally designated 21, is shown embedded in the opposed ends22 and 23 of a ligament, tendon or other elongated tissue member 24 ofthe type which experiences longitudinal excursions during use. Tendon orligament 24 has been severed or ruptured and accordingly has opposedtendon ends 22 and 23, which can be seen to be substantially axiallyaligned. End faces 28 and 29 of the tendon or ligament are insubstantially abutting relationship, and in the form of repair splintshown in FIGS. 1 and 2, entire splint 21 is embedded inside ends 22 and23 of member 24. Accordingly, in the embodiment of the present inventionof FIGS. 1 and 2, splint 21 has a width dimension, w, which is less thanthe nominal width dimension, W, of member 24 and member ends 22 and 23.As will be appreciated, the representation in the drawings is schematicand the tendon ends will not be perfectly cylindrical, nor will theirwidth dimensions be constant.

The length dimension, 1, of splint 21 between the opposite ends 26 and27 of the splint body will be sufficient to extend inwardly of each ofthe opposed end faces 28 and 29 of tendon ends 22 and 23 by a distanceenabling securement of splint 21 to each of ends 22 and 23 by at leastone securement device, which is preferably provided by at least onetransversely extending suture, such as sutures 31.

In order to enable embedding of splint 21 into tendon or ligament ends22 or 23, it is preferable that opposite splint ends 26 and 27 areformed to enable easy urging or penetration into the tendon ends, forexample, by providing a tapered or pointed end. In the illustrated formof the splint of FIGS. 1 and 2, the splint body is formed withoppositely facing conical splint ends 26 and 27 which can be driven, orurged by pulling as described in connection with the embodiment of FIG.7, into tendon end faces 28 and 29 and urged axially along tendon ends22 and 23 until tendon faces 28 and 29 are in substantially abuttingrelation and the splint is positioned substantially as shown in FIGS. 1and 2. This structure avoids tedious tendon end slitting, as describedin the Mitsuhiro, et al. article, and minimizes the trauma to the tendonends.

Moreover, tendon or ligament repair splint 21 of the present inventionfurther includes a securement structure 32, 33, formed to cooperate witha securement device, such as a suture, resist relative axialdisplacement between splint body 21 and device or sutures 31. In theform of the splint of FIGS. 1 and 2, the splint securement structuresare provided by oppositely facing ridges or shoulders 32 and 33 againstwhich sutures 31, or tendon tissue pulled inwardly by the suture, willbear if an axial force is applied to tendon or ligament 24 in adirection tending to separate faces 28 and 29. In the illustrated splint21, a second set of suture securement shoulders 32a and 33a are providedby a second frusto-conical portion of the splint body. This allows twosutures 31 to extend transversely across each of tendon ends 22 so as topick up the oppositely facing suture securement shoulders 32, 32a and33, 33a. In FIG. 2, the sutures in end 23 have been omitted for clarityof illustration.

In order to secure the sutures 31 to splint securement structure 32, 32aand 33, 33a, the suture is first sewn into a tendon or ligament end at aposition immediately proximate the small diameter or neck portion 36immediately adjacent a selected one of the suture securement shoulders.The surgeon then comes back through the tendon end from the other sideclosely proximate an opposite side of neck portion 36 and exits near theoriginal entry into the tendon end. The suture can then be cinched downand tied off so that the loop formed in the tendon around the repairsplint neck portion 36 traps the splint as embedded in the tendon orligament end. Thus, only the tied off suture ends extend outside thetendon or ligament, and they present little resistance to longitudinalexcursion of the tendon during healing. The embedded splint assemblyalso has little tendency to adhere to surrounding tissue, againpermitting longitudinal excursions.

As will be understood, therefore, the procedure for placement of thesplint of the present invention and securement of the same to the tendonor ligament ends is relatively simple. The suturing requiresconsiderably less manipulation of the tendon or ligament than some ofthe complex suturing patterns or schemes employed in the prior art.Moreover, as will be set forth below, the resulting repaired joint has astrength which is at least equal to the best and most complex suturingpatterns, and is greatly enhanced over the relatively simple and mostoften used suturing techniques.

While use of the microsurgical repair splint of the present inventionhas been illustrated with a plurality of discrete sutures 31, it will beunderstood that other suture techniques, such as a single, runningsuture, also could be used with any splint of the present invention tosecure the splint to the tendon or ligament ends.

It will be understood, however, that securement devices other thansutures could be employed with the present split. Thus a surroundingelastic member or band could cooperate with securement shoulders 32, 32aand 33, 33a. Similarly, a band or strip with hook-and-loop fasteners(e.g., VELCRO) could be employed.

FIG. 3 illustrates an alternative embodiment of the surgical tendon andligament repair splint shown in FIGS. 1 and 2. In FIG. 3 a splint 41 isprovided which again has pointed splint ends 46 and 47 to enable thesame to be easily embedded in opposed tendon or ligament ends 42 and 43.Instead of securement shoulders which are perpendicular, splint 41includes curved or spherical enlargements 52, 52a and 53, 53a, which arespaced axially along neck portion 56 of the splint body. Sutures, oranother securement device, 51 again will be placed sufficiently close tothe rounded suture securement shoulders 52, 52a and 53, 53a that, whencinched down around neck portions 56, axial separation of tendon orligament ends 42 and 43 will require substantial force.

In an embodiment not shown in the drawing, the splint body of thepresent invention can be formed with a securement structure taking theform of an aperture in the body. Thus, for the embedded form of theinvention, the splint would have oppositely facing pointed ends, but ina wide portion of the splint body a transversely extending aperturewould be provided in each end dimensioned so that the surgeon couldsuture through the aperture when the splint was embedded in the tendonbody. This requires some additional technique, but because the aperturewould be located in a known relationship to the wide portion of thesplint body, the surgeon can palpate the tendon or ligament end tolocate the wide portion is and thereby determine the location of theaperture. Moreover, in order to angularly orient the aperture about alongitudinal axis, the splint body could be flat but formed with sharpends which avoid the necessity of slitting the tendons, as described inMitsuhiro, et al. The orientation of the aperture could be determined bypalpation.

Referring now to FIGS. 4 and 5, a further alternative embodiment of thetendon or ligament surgical repair splint of the present invention isshown. The embodiment shown in FIGS. 4 and 5 is particularly well suitedfor use on tendons or ligaments which are relatively flat or ovaloid intheir cross section. Such flat tendons may be found, for example, asextensor tendons in the human hand. Embedding a repair splint in a flattendon or ligament may be difficult or impossible. It is also possible,however, as above described, to form an embedded splint as a flatmember, rather than a member which is a surface of revolution about thelongitudinal axis of the member to be joined.

The splint, generally designated 61, of FIGS. 4 and 5 can be formed withan elongated body in the form of a thin, flat metal strip having a widthdimension, w, not substantially greater than the width dimension, W, oftendon ends 62 and 63 and a length dimension sufficient to span acrossthe opposed end faces 68 and 69 of the tendon or ligament ends 62 and 63by a distance enabling suturing to each end. In the flat strip-like formof the splint of the present invention, securement structuresadvantageously may be formed as a plurality of apertures 72 and 73dimensioned so that sutures 71 can be sewn therethrough. When thesutures 71 are cinched down and tied off, they will pull the thin splint61 into general conformance with the outside surface of tendon orligament ends 62 and 63. Thus, the thin cross section of splint 61allows it to conform closely to the exterior configuration of the tendonor ligament ends, and the metal body provides significant tensilestrength across the severed or ruptured end faces 68 and 69. As usedherein, the expression "thin" shall mean strip stock having a thicknessdimension not greater than about 0.2 millimeters, and preferably lessthan 0.1 millimeter. The preferred splint material for the splint 67 ofFIGS. 4 and 5 is medical grade stainless steel since it is corrosionresistant and has high strength in very thin sections, but other metalalloys having high corrosion resistance can be used. Stainless steel andother metal alloys also will be smooth and in thin sections will conformto the member being repaired and glide smoothly along surroundingtissues during longitudinal excursions of the tendon. Such smoothstainless steel splints also will tend not to adhere to surroundingtissues.

As will be appreciated, it also would be possible to employ a pair ofstrip-like splints 61 on each side of relatively flat tendon or ligament64 so as to provide further strength across the joint between the memberends. It has been found that for many applications, however, that only asingle splint 61 needs to be employed to achieve ultimate tensilestrength across the joint which is at least twice that of a standardKessler suture technique. Nevertheless, further strength would beachieved through the use of a second repair splint, although there wouldbe attendant time required to secure the same to the tendon or ligamentends.

In FIG. 6, a further alternative embodiment of strip-type repair splintof the present invention is shown. Repair splint 81 again is formed froma thin, flat metal strip having a length sufficient to span across theopposed faces 88 and 89 of tendon or ligament ends 82 and 83. The widthdimension is again preferably not substantially greater than the nominalwidth dimension of the ends 82 and 83 of the member to be joinedtogether so as not to protrude laterally of the member. Since thinstrips will conform to the tendon when cinched down excess width can betolerated by pulling the strip down around the tendon or ligament. Inthe extreme the strip can wrap completely around the tendon.

In the embodiment shown in FIG. 6, the securement structure is providedby notches 85 in oppositely facing sides of strip 81 that affordoppositely facing shoulders or ridges 92 and 93 against which asecurement device, such as sutures 91, can bear. Again, repair splint 81is sutured to a side of member 84 which is to be repaired, and splint 81can advantageously be formed from a medical grade stainless steelmaterial. Alternatively, the side of splint 81 contacting the tendon orligament can be formed as a roughened surface which will adhere to thetendon or ligament ends when secured in place by a securement device,which could include an adhesive.

Referring now to FIG. 7, an alternative embodiment of the present splintis shown which is similar to the embodiment of FIGS. 1 and 2.

Surgical repair splint 121 is shown embedded in a tendon or ligamentmember (phantom) 124 which has been ruptured or severed and has aligned,opposed ends 122 and 123 with abutting end faces 128 and 129. In theembodiment of FIG. 7, splint 121 has a central splint body 136 which isflexible relative to the pair of opposite facing splint ends 126, 126aand 127, 127a to which central body 136 is coupled.

In the preferred form, central splint body 136 is provided by a medicalgrade stainless suture, for example, No. 5 to No. 10 (diameter)stainless suture material. Opposite ends of central splint body can beswaged at 130 and 135 to splint ends 126 and 127 by stems 140 providedon the innermost splint ends 126a and 127a using a swaging techniquewell known in the medical industry in connection with securing suturesto needles.

The splint ends 126, 126a and 127, 127a can be formed of cast, machinedor otherwise formed metal or plastic material which is both pointed andsufficiently rigid to enable penetration of end faces 128 and 129 of thetendon or ligament 124. When central splint portion 136 is a flexiblestainless steel suture, splint ends 126, 126a and 127, 127a arepreferably also formed of medical grade stainless steel. If flexiblesplint central body 136 is formed from a flexible plastic or syntheticmaterial, ends 126, 126a and 127, 127a advantageously may be similarlyformed, either monolithically with central splint body 136 or adhesivelysecured to central splint body 136.

Splint ends 126, 126a and 127, 127a are shown as being provided by twotriangular members with pointed ends facing away from each other andlarge diameter ends facing toward central splint body 136 and eachother. A single triangular member also could be used, and it also willbe understood that splint ends also could be frusto-conical members asshown in FIGS. 1 and 2. The thickness dimension of triangular splintends 126, 126a and 127, 127a preferably is about equal to the diameterof central splint body 136.

The large diameter ends 133, 133a of splint end 126, 126a and the largediameter ends 132, 132a of splint end 127, 127a provide oppositelyfacing shoulders which act as securement structures against which asecurement device, such as a transverse suture 131 may cooperate tosecure the tendon ends 122 and 123 against axial separation.

Three types of securement devices are shown in phantom in FIG. 7,namely, a resilient band 131a around an exterior of tendon or ligament124. Band 131a pulls the tendon tissue behind shoulder 133 radiallyinwardly to resist displacement of tendon end 122 to the left in FIG. 7.Securement device 131 is a single suture sewn through the tendon endproximate and inwardly or behind shoulder 133a. Finally, securementdevice 131b is a single running suture sewn across tendon end 123 behindor inwardly of both shoulders 132 and 132a.

As thus far described, splint 121 could be embedded into tendon orligament 124 using a pushing instrument (not shown). Thus, the pointedends 126 and 127 could be urged or driven by an instrument into each ofend faces 128 and 129 of tendon or ligament 124. In the preferred formillustrated in FIG. 7, however, splint 121 has at least one needle, andpreferably a pair of needles 151 and 152, secured to splint ends 126,126a and 127, 127a. Needles 151 and 152 are coupled to pointed splintends 126 and 127 by flexible sutures or threads 153 and 154, which againcan be either 4.0 to zero (diameter) stainless steel or braidedpolyester (TYCRON)material of the type which is conventionally used inneedle/suture assemblies. Thus, needle 151 will be joined at 156 toflexible suture 153, which in turn is joined at 157 to pointed end 126of the splint end 126, 126a. Needle 152 will be joined at 158 toflexible suture 154 which is coupled at 159 to pointed end 127 of splintend 127, 127a.

In use, one of the needles 151 and 152 is urged into one of end faces128 and 129, and the needle is advanced axially up the correspondingtendon end 122 or 123 until it is well beyond the farthest position atwhich the splint end 126 or 127 is to reach. The needle is then advancedthrough a side wall of the tendon or ligament end and used to pull thecorresponding splint end, either 126 or 127, axially into the tendonuntil the end reaches the position shown in FIG. 7. The process isrepeated for the other needle and the other tendon end.

The two sutures 153 and 154 attached to the splint ends are pulledaxially in opposite directions until end faces 128 and 129 are inabutting relation and flexible splint body 136 is tensioned. Flexiblesutures 153 and 154 may be cut off flush with the side wall of thetendon to remove needles 151 and 152. Transverse securement devices 131,131a or 131b are preferably used to secure tendon ends 122 and 123 toshoulders 132, 132a and 133, 133a of the splint to resist separation ofthe tendon ends before cutting off needles 151 and 152.

Having described the surgical splint apparatus of the present invention,the method of joining together opposed ends of a ruptured or severedtendon or ligament can be set forth. The method of the present inventionincludes the steps of positioning opposed ends of the member to bejoined together in substantially axially aligned and substantiallyabutting relationship. Most preferably, the end faces of the tendon endsare abutting to form a butt joint, but other joints such as lap jointscan be formed using the repair splint and method of the presentinvention.

In one aspect of the method of the present invention, the first step isurging an elongated repair splint having a width dimension less than theopposed ends into each end of the tendon or ligament, either by pushingthe splint into the tendon end face or pulling into the end face, asdescribed in connection with FIG. 7. The repair splint is urged into thetendon ends until the opposed faces of the member ends are substantiallyabutting so that they will be held together for knitting and biologicalreconstruction. Finally, the method includes the step of securing eachof the opposed tendon or ligament ends to a securement structure on thesplint to secure the opposed ends to the splint while embedded therein.

Thereafter, the present method can include the steps of allowing theopposed ends to knit together while sutured to the splint.

In another aspect of the method of the present invention, the repairsplint is applied to the severed or ruptured tendon or ligament by thestep of placing an elongated, thin, flat metallic strip splint in aposition to span across opposed faces of the member ends by a distancewhich is sufficient to enable suturing of opposite splint ends to theopposed tendon or ligament ends. The splint is placed in contact with aside of the member to be joined and preferably has a width dimension notsubstantially greater than the width dimension of the member to bejoined. The repair splint is formed with securement structure proximateeach of the splint ends, and, as above described, the next step is tosecure each of the opposite splint ends of the flat splint to the memberends to be joined while they are in aligned and abutting relationship.

The following Table 1 illustrates the improvement in strength possibleby using the surgical repair splints of the present invention, ascompared to an intact tendon and a standard Kessler repair technique.All measurements were made on an Instron tensiometer.

The metal splints were constructed as shown in FIGS. 4 and 5 with awidth dimension, w, of 4 millimeters, a length dimension, 1, of 30millimeters and a thickness dimension of 0.5 millimeters from stainlesssteel. A staggered suture securement aperture pattern, as shown in FIG.5, was employed. The embedded splint with cones was constructed as shownin FIGS. 1 and 2 and had an overall length dimension of 18 millimeterswith a maximum width dimension of three millimeters. The distancebetween the first pair of opposed shoulders 32a and 33a was sixmillimeters and the distance from shoulders 32a to end 27 and 33a to end26 was also six millimeters. The diameter of neck portion 36 was onemillimeter, and the splint was made from stainless steel. Othermaterials could be used.

                                      TABLE 1                                     __________________________________________________________________________    Strengths of an intact tendon and of various cut tendon's repairs.                      MAX. LIN.                        ULTIMATE                                     TENSILE      EPSILON             TENSILE                                      STRENGTH                                                                             SIGMA (mm/mm)             STRENGTH                           PARAMETERS                                                                              (lb)   (lb/mm.sup.2)                                                                       elongation                                                                          STIFFNESS                                                                            RESILIENCE                                                                           (lb)                               __________________________________________________________________________      Types                                                                         of Repair                                                                     Intact  57.34 ± 10.55                                                                     9.23 ± 2.31                                                                      0.65 ± 0.22                                                                      15.22 ± 4.49                                                                      3.18 ± 1.78                                                                       62.24 ± 9.03                      tendon                                                                        Standard                                                                              4.44 ± 0.56                                                                       0.44 ± 0.04                                                                      1.78 ± 0.22                                                                      0.25 ± 0.05                                                                       0.39 ± 0.02                                                                        4.72 ± 0.28                      Kessler                                                                       Embedded                                                                              16.57 ± 0.34                                                                      1.09 ± 0.02                                                                      0.85 ± 0.15                                                                      1.33 ± 0.24                                                                       0.47 ± 0.09                                                                       19.00 ± 1.67                      with cones                                                                    Metal strip                                                                           11.52 ± 2.33                                                                      0.77 ± 0.14                                                                      1.59 ± 0.20                                                                      0.50 ± 0.13                                                                       0.60 ± 0.08                                                                       13.28 ± 1.22                      splint (a)                                                                    Metal   9.05 ± 0.35                                                                       0.59 ± 0.04                                                                      1.20 ± 0.00                                                                      0.49 ± 0.03                                                                       0.35 ± 0.02                                                                       10.70 ± 0.10                      splint (b).sup.(2)                                                          __________________________________________________________________________

As will be seen from Table 1, the embedded surgical repair splint of thepresent invention had an ultimate joint strength of more than four timesthat of a standard Kessler repair. The flat metal repair splints had anultimate repair strength across the joint of two-to-three times that ofa Kessler repair.

The surgical repair splints of the present invention also can be formedof a material which is capable of being absorbed by the body over timeso that the splint does not have to be removed. Thus, a polylactatematerial or a material made from polyglycolic acid are examples ofabsorbable materials having sufficient tensile strength to provide highstrength to the repaired joint. Other absorbable materials would besuitable provided that they have sufficient tensile strength. Inconnection with the flat strip-like repair splints, it is also possibleto come back in and remove the splint, particularly if it is a metalsplint, so that prolonged contact with the body will not cause corrosionor infection. Obviously, it is preferable that if an embedded repairsplint is made of a metal, which is possible, that it is made of asurgical grade stainless steel or other metal alloy capable of beingembedded substantially indefinitely in a patient. Similarly, such metalalloy splints can be employed with a strip splint and the splint left inplace.

What is claimed is:
 1. A surgical repair splint for holding togetheropposed member ends of a severed or ruptured tendon or ligament duringhealing of said member comprising:a relatively flexible length of suturematerial providing central splint body having opposed body ends; a pairof pointed splint ends formed of a relatively rigid material forpenetration of said opposed member ends and coupled to said opposed bodyends with said pointed splint ends facing away from each other, saidpointed splint ends further each having a transverse shoulder facingtoward said central splint body dimensioned for receipt of atransversely extending suture proximate said shoulder to resist axialseparation of said opposed member ends during excursion of said member;flexible sutures attached at one end to each of said pair of pointedends; needles attached to an opposite end of each flexible suture; andsaid central splint body, said splint ends, said sutures and saidneedles each having a width dimension less than a nominal widthdimension of said member.
 2. The surgical splint as defined in claim 1wherein,said central splint body is provided by a metal suture materialand said pointed splint ends are provided by triangular metallic ends.3. The surgical splint as defined in claim 2 wherein,said suturematerial and said pointed splint ends are all made from medical gradestainless steel.
 4. A surgical repair splint in combination with asecurement device to hold together opposed member ends of a severed orruptured flexor tendon or ligament member subject to axial excursionsduring healing of said member comprising:an elongated flexible centralsplint body; pointed relatively rigid opposite splint ends coupled tosaid central splint body and formed to penetrate into each of saidopposed member ends, said splint having a length extending inwardly ofeach of said opposed member ends by a distance sufficient to enablesecurement of said splint ends to said member on opposite sides of saidopposed member ends, and said splint ends further being formed with ashoulder facing toward said central splint body; said central splintbody and said splint ends having a width dimension less than a nominalwidth dimension of said member; and a securement device formed to engagesaid member without protruding from said member by an amount sufficientto impede excursions of said member, said securement device beingpositioned between the shoulders and formed to cooperate with theshoulders to resist axial separation of said opposed ends duringexcursions of said member during healing.
 5. The splint and securementdevice as defined in claim 4 wherein,said securement device is providedby at least one suture extending around a portion of said splint bodybetween each said shoulder.
 6. The splint and securement device asdefined in claim 4 wherein,said central splint body is provided by alength of suture material; said pointed relatively rigid splint ends areprovided by triangular members and said shoulders are provided by largeends of said triangular members.
 7. The splint and securement device asdefined in claim 4, anda length of flexible suture material secured toeach of said splint ends and adapted to extend transversely through aside wall of said member.